title: Significance of arterial hyperoxia and relationship with case fatality in traumatic brain injury: a multicentre cohort study.
abstract: OBJECTIVE
  In this retrospective multi-centre cohort study, we tested the hypothesis that hyperoxia was not associated with higher in-hospital case fatality in ventilated traumatic brain injury (TBI) patients admitted to the intensive care unit (ICU).
  
  
  METHODS
  Admissions of ventilated TBI patients who had arterial blood gases within 24 h of admission to the ICU at 61 US hospitals between 2003 and 2008 were identified. Hyperoxia was defined as PaO2 ≥300 mm Hg (39.99 kPa), hypoxia as any PaO2 <60 mm Hg (7.99 kPa) or PaO2/FiO2 ratio ≤300 and normoxia, not defined as hyperoxia or hypoxia. The primary outcome was in-hospital case fatality.
  
  
  RESULTS
  Over the 5-year period, we identified 1212 ventilated TBI patients, of whom 403 (33%) were normoxic, 553 (46%) were hypoxic and 256 (21%) were hyperoxic. The case-fatality was higher in the hypoxia group (224/553 [41%], crude OR 2.3, 95% CI 1.7-3.0, p<.0001) followed by hyperoxia (80/256 [32%], crude OR 1.5, 95% CI 1.1-2.5, p=.01) as compared to normoxia (87/403 [23%]). In a multivariate analysis adjusted for other potential confounders, the probability of being exposed to hyperoxia and hospital-specific characteristics, exposure to hyperoxia was independently associated with higher in-hospital case fatality adjusted OR 1.5, 95% CI 1.02-2.4, p=0.04.
  
  
  CONCLUSIONS
  In ventilated TBI patients admitted to the ICU, arterial hyperoxia was independently associated with higher in-hospital case fatality. In the absence of results from clinical trials, unnecessary oxygen delivery should be avoided in critically ill ventilated TBI patients.
authors.affiliation: Department of Neurology, Divisions of Critical Care and Neurotrauma, Philadelphia, Pennsylvania, USA Department of Neurology Neurosurgery, Divisions of Critical Care and Neurotrauma, Philadelphia, Pennsylvania, USA.
authors.forename: Fred
authors.initials: F
authors.lastname: Rincon
authors.affiliation: Department of Neurology, Divisions of Critical Care and Neurotrauma, Philadelphia, Pennsylvania, USA.
authors.forename: Joon
authors.initials: J
authors.lastname: Kang
authors.affiliation: Department of Neurology, Divisions of Critical Care and Neurotrauma, Philadelphia, Pennsylvania, USA Department of Neurology Neurosurgery, Divisions of Critical Care and Neurotrauma, Philadelphia, Pennsylvania, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Vibbert
authors.affiliation: Department of Neurology, Divisions of Critical Care and Neurotrauma, Philadelphia, Pennsylvania, USA Department of Neurology Neurosurgery, Divisions of Critical Care and Neurotrauma, Philadelphia, Pennsylvania, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Urtecho
authors.affiliation: Department of Neurology Neurosurgery, Divisions of Critical Care and Neurotrauma, Philadelphia, Pennsylvania, USA Department of Neurology Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: M Kamran
authors.initials: MK
authors.lastname: Athar
authors.affiliation: Department of Neurology Neurosurgery, Divisions of Critical Care and Neurotrauma, Philadelphia, Pennsylvania, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Jallo
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000097:blood / Q000401:mortality*; D005260:Female; D006801:Humans; D018496:Hyperoxia / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012121:Respiration, Artificial / Q000401:mortality; D012189:Retrospective Studies; D055815:Young Adult
keywords: Intensive Care; Neurosurgery